Provider Demographics
NPI:1225349491
Name:HOLDER, KYLE (OTR)
Entity type:Individual
Prefix:MS
First Name:KYLE
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HARMON ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2707
Mailing Address - Country:US
Mailing Address - Phone:516-312-5123
Mailing Address - Fax:516-432-0725
Practice Address - Street 1:19620 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2101
Practice Address - Country:US
Practice Address - Phone:516-312-5123
Practice Address - Fax:516-432-0725
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011159-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist